Organization Active NPI

Graceful Care Home Health Services Inc.

  • Home Health Agency
  • Anaheim, CA
National Provider Identifier
1083329957
Registry record updated Jan 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
GRACEFUL CARE HOME HEALTH SERVICES INC.
Practice address
1775 E Lincoln Ave Ste 203
Anaheim, CA 92805-4324
Phone
(714) 860-4425
NPI assigned
Jan 16, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jade Hanson
Title
Complaence Officer
Phone
(916) 934-4913

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

1775 E Lincoln Ave Ste 203
Anaheim, CA 92805-4324

Mailing address

1775 E Lincoln Ave Ste 203
Anaheim, CA 92805-4324

Other names 1

  • Graceful Care Home Health Services Inc. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240415003100 CA Part A Provider - Home Health Agency 4183063837 Practice locations: Anaheim, CA

Home health agency certification: CCN 757902

Legal name
GRACEFUL CARE HOME HEALTH SERVICES INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Feb 18, 2025
Last certification
Feb 6, 2025
Organization structure
CorporationProprietary
Incorporated
May 16, 2022 in CA
Enrollment address
1775 E Lincoln Ave
Ste 203
Anaheim, CA 92805-4324

Care Compare: Home health agency

Medicare Care Compare
Listed as
Graceful Care Home Health Services Inc.CCN 757902
Ownership
-
Certified
Feb 18, 2025
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

1775 E Lincoln Ave
Ste 203A
Anaheim, CA 92805
Phone (714) 699-2911

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Basil Issa Individual 5% Or Greater Direct Ownership InterestCeo/Cfo/Secretary May 16, 2022 100%
Corporate OfficerCeo/Cfo/Secretary May 16, 2022 100%
W-2 Managing EmployeeCeo/Cfo/Secretary May 16, 2022 100%

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1673827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673827200000",
    "number": "1083329957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1775 E LINCOLN AVE STE 203",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928054324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 E LINCOLN AVE STE 203",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928054324",
            "telephone_number": "714-860-4425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACEFUL CARE HOME HEALTH SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-16",
        "last_updated": "2023-01-16",
        "certification_date": "2023-01-16",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "JADE",
        "authorized_official_title_or_position": "COMPLAENCE OFFICER",
        "authorized_official_telephone_number": "916-934-4913"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Graceful Care Home Health Services Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anaheim, CA

Sources for this page

Verify at the official NPI Registry.